Trigger Point Dry Needling

by Dr. Sarah Cash Crawford, PT, DPT, COMT

Trigger Point Dry Needling

Dry needling is a technique used mostly by physical therapists and occasionally by chiropractors, medical doctors and dare I say, acupuncturists. You may be asking: Is it not the same as acupuncture? That is a very short answer: no! Acupuncture is based on traditional Chinese medicine in which the belief is that our bodies are fed by a variety of energy channels which have grand central stations of flow (“chi”). A needle is inserted into those central stations to increase energy to a given body system, such as the low back. 

History of Trigger Point Dry Needling

Trigger point dry needling came about in the United States as a practice for physical therapists in the early 1980’s as a result of studies performed by Dr. Janet Travell, a cardiologist at Beth Israel Hospital in New York and the first female physician to the President of the United States (President Kennedy, 1960). Dr. Travell observed a trend in her patients presenting with cardiac symptoms. Upon testing, the symptoms were not found to be coming from the heart. Further examination found that when she pressed on a spot between the 5th and 6th rib on the right side of the patient’s body she could reproduce their cardiac pain. Ah ha! Already a believer in referred pain, this was the evidence she needed to develop a hypotheses. Thereafter, Dr. Travell partnered with Dr. David Simmons, an aerospace physician who wrote The Trigger Point Manual, which has become the primary teaching tool for medical professionals on the diagnosis and treatment of myofascial pain. With their collective knowledge Dr. Travell convinced some unbelieving physician friends of hers to begin treating trigger points with pain medication. Initially the treatment of choice was procaine, an injectable analgesic. Eventually she tried less invasive options like topical spray analgesics. Unfortunately, she found that both provided only temporary relief of symptoms.

Wanting to know more about trigger points, further studies were performed. It was then found that the inflammatory chemicals found inside these trigger points (taut bands of muscle) are the contributing factors to on-going dysfunction of the muscular fiber and subsequent pain. This new information lead investigators to the use of steroids (anti-inflammatories) as a treatment option. When research ensued, comparison studies were performed to find the better outcome—injection of analgesic (pain medication) versus steroids (anti-inflammatories). Such studies required the use of a control group (saline solution) that would also be injected into the trigger point of certain subjects. Upon follow up at six and 12 months, it was found that the subjects who were injected with saline had the better outcomes! WHAT? WHY? The answer is easy: the needle. We have known for hundreds of years that muscles respond to mechanical pressure. A needle, on the other hand, goes beyond providing mechanical pressure. A needle placed into a trigger point causes a local muscle twitch response from within the muscles which then causes a dump of the inflammatory agents that have accumulated in your muscles. Getting rid of these inflammatory agents is important because they impede the brains ability to tell the muscle what to do and when to do it. After the results of this study, subsequent researched focused on the use of thin, mono-filiform needles that would not cause any tissue shearing or damage—aka, the well known “acupuncture needle”. It was found that this “dumping” and release of the trigger point thereby results in a reduction in pain locally and referred. It also allows the brain to more efficiently control the muscle which will also assist in the healing process. 

Dry Needling vs Acupuncture

So, how then is dry needling really any different from acupuncture? The overall philosophy of dry needling and acupuncture are very different. Dry Needling starts with a thorough examination to determine if the source of symptoms arises from or is contributed by the presence of a myofascial trigger point(s). If the symptoms are determined to be arising from the trigger point, then the “dry” needle (“dry” refers to a needle without medication) is inserted directly into the taut bands of muscle to elicit the inflammatory-dumping muscle twitch. Acupuncture, on the other hand, does not directly assess for these trigger points to insert the needle into with the goal of eliciting a twitch. Rather, acupuncture attempts to restore a flow of energy by facilitating the unblocking of one’s chi. 

Is Dry Needling For Everyone? 

It is the job of the practitioner to determine whether dry needling is the best option for you, because it is not for everyone. Dry needling happens to be another tool in the toolbox for a clinician. Besides dry needling, there are other ways to treat trigger points —myofascial and manual trigger point releases are examples. Ultimately, successful use of dry needling is dependent on a skillful evaluation by a properly trained healthcare clinician—preferably someone who has received and been tested in an advanced certification for trigger point dry needling. Trigger point dry needling has been proven to be highly successful in the treatment of a variety of common musculoskeletal conditions such as headache, low back pain, plantar fasciitis, carpal tunnel, frozen shoulder, chronic pain, IT Band syndrome, muscles strains, and many more.